Due to development of new prosthetic heart valves(PHV) and advanced operative technology, the result of prosthetic valve replacement has improved, but problems such as thromboembolism, bleeding, structural valve deterioration, and patient-prosthesis mismatch are not yet resolved. The aging society, different life style and sensual change for life affected the type of operation and life quality after the operation. During four decades, the mechanical valve has been designed for less or no structural valve deterioration and manufacturers have mixed high-tech for prevention of thrombosis. However, the necessity of anticoagulation therapy is still remained. And the durability of the tissue valve has also been increased by development in technology of tissue preservation and fixation. But the risk of thromboembolism and structural failure is not completely resolved and it is far from perfect for replacing the mechanical valve. The long-term result of homograft is disappointing. However, the result of the pulmonary autograft is hopeful, except that it needs a very complex operation and therefore, it is limited to an experienced surgeon. Recent study shows that patient's characteristics are important to determine the long-term results and durability of the prosthetic valve. It needs to be reemphasized that, for better results of PHV replacement, we consider the patient's characteristics and types of PHV and discuss the options with our patients.
Aging ; Allografts ; Autografts ; Heart Valves* ; Heart* ; Hemorrhage ; Hope ; Humans ; Life Style ; Quality of Life ; Thromboembolism ; Thrombosis ; Tissue Preservation

Due to development of new prosthetic heart valves(PHV) and advanced operative technology, the result of prosthetic valve replacement has improved, but problems such as thromboembolism, bleeding, structural valve deterioration, and patient-prosthesis mismatch are not yet resolved. The aging society, different life style and sensual change for life affected the type of operation and life quality after the operation. During four decades, the mechanical valve has been designed for less or no structural valve deterioration and manufacturers have mixed high-tech for prevention of thrombosis. However, the necessity of anticoagulation therapy is still remained. And the durability of the tissue valve has also been increased by development in technology of tissue preservation and fixation. But the risk of thromboembolism and structural failure is not completely resolved and it is far from perfect for replacing the mechanical valve. The long-term result of homograft is disappointing. However, the result of the pulmonary autograft is hopeful, except that it needs a very complex operation and therefore, it is limited to an experienced surgeon. Recent study shows that patient's characteristics are important to determine the long-term results and durability of the prosthetic valve. It needs to be reemphasized that, for better results of PHV replacement, we consider the patient's characteristics and types of PHV and discuss the options with our patients.
Aging ; Allografts ; Autografts ; Heart Valves* ; Heart* ; Hemorrhage ; Hope ; Humans ; Life Style ; Quality of Life ; Thromboembolism ; Thrombosis ; Tissue Preservation

Since sclerosing hemangioma of the lung was first described by Liebow and Hubbell in 1956, there have been several reports on cases occurring as a solitary nodule; however, sclerosing hemangiomas occurring as multiple nodules are extremely rare. The histogenesis of this tumor remains controversial and there are several hypotheses of the etiology. Three separate nodules were found in a 57-year-old housewife, one found in the right middle lobe, one in the apicoposterior segment of the left upper lobe, and one in the superior segment of the left lower lobe. The only symptom or sign presented was a dry cough. Apicoposterior segmentectomy of the left upper lobe and wedge resection of the superior segment of the left lower lobe were performed. The postoperative course was uneventful and the patient was discharged on the postoperative 15th day.
Cough ; Hemangioma ; Histiocytoma, Benign Fibrous* ; Humans ; Lung Neoplasms ; Lung* ; Mastectomy, Segmental ; Middle Aged ; Pulmonary Sclerosing Hemangioma

BACKGROUND: Hypothermia protects the brain by suppressing the cerebral metabolism and it is performed well enough before the total circulatory arrest(TCA) in the operation of aortic disease. Generally, TCA has been performed depending on the rectal or nasopharyngeal temperatures; however, there is no definite range of optimal temperature for TCA or an objective indicator determining the temperature for safe TCA. In this study, we tried to determine the optimal range of temperature for safe hypothermic circulatory arrest by using the intraoperative electroencephalogram(EEG), and studied the role of EEG as an indicator of optimal hypothermia. MATERIAL AND METHOD: Between March, 1999 and August 31, 2000, 27 patients underwent graft replacement of the part of thoracic aorta using hypothermia and TCA with intraoperative EEG. The rectal and nasopharyngeal temperatures were monitored continuously from the time of anesthetic induction and the EEG was recorded with a ten-channel portable electroencephalography from the time of anesthetic induction to electrocerebral silence(ECS). RESULT: On ECS, the rectal and nasopharyngeal temperatures were not consistent but variable(rectal 11degree C -25degree C, nasopharynx 7.7degree C -23degree C). The correlation between two temperatures was not significant(p=0.171). The cooling time from the start of cardiopulmonary bypass to ECS was also variable(25-127min), but correlated with the body surface area(p=0.027). CONCLUSION: We have found that ECS appeared at various body temperatures, and thus, the use of rectal or nasopharyngeal temperature were not useful in identifying ECS. Conclusively, we can not fully assure cerebral protection during hypothermic circulatory arrest in regards to the body temperatures, and therefore, the intraoperative EEG is one of the necessary methods for determining the range of optimal hypothermia for safe circulatory arrest.
Aorta, Thoracic ; Aortic Diseases ; Body Temperature ; Brain ; Cardiopulmonary Bypass ; Electroencephalography* ; Humans* ; Hypothermia ; Metabolism ; Nasopharynx ; Transplants

Vasodilatory shock has been implicated in life-threatening complications after cardiac surgery. This syndrome may result from the vasopressin deficiency following cardiopulmonary bypass (CPB), which do not respond to fluids or usual intravenous inotropes. We used arginine-vasopressin in adults with vasodilatory shock coming off cardiopulmonary bypass. Therefore, we report these cases with a review of articles.
Adult ; Arginine Vasopressin* ; Arginine* ; Cardiopulmonary Bypass* ; Diabetes Insipidus, Neurogenic ; Humans ; Shock* ; Thoracic Surgery ; Vasodilation ; Vasopressins

Broncholithiasis is uncommon in patients with silicosis. Bronchoesophageal fistula complicated by broncholithiasis is especially rare and only one case has been reported in Korea. Surgical treatment of broncholithiasis should be as conservative as possible to preserve the adequate pulmonary function. Meticulous dissection and division of the fistula with the interposition of viable tissues will prevent recurrence. We report a rare case of bronchoesophageal fistula complicated by broncholithiasis in a patient with silicosis.

No abstract available.
Myocardial Infarction

PURPOSE: The purpose of this study was to examine medical students' perceptions of team-based learning (TBL) according to their individual characteristics: gender, team efficacy, interpersonal understanding, proactivity in problem solving, and academic ability. METHODS: Thirty-eight second-year medical students who took an integrated cardiology course participated in this study; 28 were male and 10 were female. A questionnaire on individual characteristics and a questionnaire on the perception of TBL were administered, and the scores of individual characteristics were grouped into three: high, middle, and low. The data were analyzed by t-test, analysis of variance, and multiple regression analysis. RESULTS: The TBL efficacy perception scale consisted of 3 factors: team skill, learning ability, and team learning. The group of male students and the group of students with high academic ability recognized the effect of TBL on improvements in learning ability more than females and those with low academic ability. The group of students with high team efficacy reported that TBL was effective with regard to team skill improvement. The group of students with high scores on interpersonal understanding and high proactive problem solving tended to perceive the TBL's effect on team skill improvement. Team efficacy and proactivity in problem solving had a positive effect on the perception of TBL. CONCLUSION: Medical students' perceptions of the effectiveness of TBL differ according to individual characteristics. The results of this study suggest that these individual characteristics should be considered in planning of team learning, such as TBL, to have a positive impact and stronger effects.
Cardiology ; Female ; Humans ; Learning ; Male ; Problem Solving ; Schools, Medical ; Students, Medical ; Surveys and Questionnaires

BACKGROUND: Prosthetic annuloplasty rings are used for the reconstruction of the mitral valve annulus. However, there is controversy over the best ring to use for reconstruction. In this study, we evaluated the long term result of using a Teflon felt strip as an alternative to commercial rings. MATERIAL AND METHOD: From 1996 to 2007, we enrolled 47 patients with pure mitral regurgitation greater than grade III. All patients had an ejection fraction of 40% or more. Patients with congenital heart disease or other valvular heart disease were excluded from this study. They were divided into two groups; the commercial ring group (Group CR) and the Teflon felt ring group (Group TF). RESULT: There was no mortality. The postoperative echocardiography showed no significant change in the overall ejection fraction (from 58.0+/-11.2% to 42.8+/-8.4%). There were no significant differences between the two groups with regard to morbidity, the reoperation rate and recurrence of mitral regurgitation greater than grade II. CONCLUSION: The long term results from this study showed that posterior mitral annuloplasty using Teflon felt had similar results compared to annuloplasty using commercial rings.
Echocardiography ; Heart Diseases ; Heart Valve Diseases ; Humans ; Mitral Valve ; Mitral Valve Annuloplasty ; Mitral Valve Insufficiency ; Polytetrafluoroethylene ; Recurrence ; Reoperation

Transfusion associated graft-versus-host disease is a rare but fatal disease reported after open heart surgeries mainly in Asian people.It can be prevented by pretransfusion gamma irradiation of the fresh whole blood. In this presentation,we report a case of transfusion associated graft-versus-host disease following coronary artery bypass surgery in a 61 year-old male patient.Postoperatively the patient was transfused urgently with 2 units of fresh whole blood from his two sons. He was discharged on postoperative 10 day with only symptom of mild diarrhea.Two days after discharge,he was readmitted because of persistent diarrhea,systemic erythema and high fever.On laboratory examinations,he showed findings of failure in liver,kidney, gastrointestinal tract,and bone marrow.Hemodynamically he deteriorated acutely and died of multiple organ failure on 17th postoperative day. This has been our first experience since we started open heart program at our hospital and we changed our policy for the transfusion of the fresh whole blood after this event.
Asian Continental Ancestry Group ; Blood Transfusion ; Coronary Artery Bypass ; Erythema ; Graft vs Host Disease* ; Heart* ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Thoracic Surgery*